Self-assessed Visual Function Research Articles

Self-assessed visual function outcome in cataract surgery: minimum important difference of the Catquest-9SF questionnaire.

The purpose of this study was to study the minimum important difference (MID) of the Catquest-9SF questionnaire in cataract surgery. A nationwide multi-center prospective randomized study was conducted using the Swedish National Cataract Register and the Catquest-9SF questionnaire. Randomized patients (n = 400) who had completed the Catquest-9SF before surgery and threemonths after surgery were sent an anchor question on self-assessed change in visual function after cataract surgery 14days after the postoperative Catquest-9SF. Rasch analysis was performed on the preoperative and postoperative Catquest-9SF questionnaires, and the patients were dichotomized with regard to their preoperative Rasch score. The MID range of the two groups was calculated based on the anchor question, and the anchor question based MID was then estimated in a scatter plot. The MID was also estimated based on distribution by calculating Cohen's effect size. The analyses included 231 patients who had completed the Catquest-9SF on both occasions as well as the questionnaire with the anchor question. The group with better preoperative visual function had an anchor question based MID of - 0.5 and a Cohen's effect size based MID of - 1.07. The group with worse preoperative visual function had an anchor question based MID of -1.80 and a Cohen's effect size based MID of - 1.46. This article contributes detailed knowledge of the MID of Catquest-9SF, enabling even more accurate high-quality evaluation of the outcome and benefit of cataract surgery worldwide.

Incidence of corneal transplantation after challenging cataract surgery in patients with and without corneal guttata.

To study the risk for corneal transplantation after phacoemulsification with dense cataract or posterior capsule rupture (PCR) and the impact of corneal guttata. Forty-nine Swedish cataract surgical units and 8 Swedish cornea transplantation units. Registry-based cohort study. Patient data from the Swedish National Cataract Registry (2010 to 2012) were linked with data from the Swedish Cornea Transplant Registry (2010 to 2017). The outcome measures were risk for future corneal transplantation, visual acuity, and self-assessed visual function after phacoemulsification. Logistic and Poisson regression analyses with adjustment for confounder effects were used to investigate the association of the outcome measures with dense cataract, indicated by trypan blue capsular staining (TB) and PCR, separately and together. Altogether, data from 276 362 cataract patients were linked with data from 2091 patients with endothelial failure who underwent corneal transplantation.The risk for future corneal transplantation increased more than 3-fold with the presence of dense cataract or PCR, and a trend toward an ever-higher risk with the combination of TB and PCR together, but without any significant synergy of corneal guttata. Dense cataract, but not PCR, was significantly associated with an increased probability of inferior visual acuity after phacoemulsification. The impact on satisfaction was not statistically significant for any of the factors. Challenging cataract surgery increases the risk for future corneal transplantation equally in patients both with and without corneal guttata, despite a more vulnerable endothelium in the guttata group. This supports a strategy where PCR is limited and handled optimally and that cataract surgery is performed before the cataract turns critically dense.

Validation and application of Catquest-9SF in various populations: A systematic review

Cataract is a common cause of reversible blindness. Visual acuity alone is not enough to assess appropriateness for surgery, prioritization, and outcomes. Catquest-9SF questionnaire evaluates patients' self-assessed visual function as related to daily tasks. We summarize and assess the validity of Catquest-9SF as a patient-reported outcome questionnaire to determine its suitability for clinical use. Thirteen studies with sample sizes ranging 102–10,886 (total n = 15,289) undertaken from 2009 to 2018 were included. Catquest-9SF showed unidimensionality, ordered response thresholds, and acceptable precision in all studies. Nine studies had significant mistargeting (range 0.66 to −2.04); the tasks being easy relative to the respondent ability in most studies. Two studies had misfitting items. We conclude Catquest-9SF is a valid and reliable tool to measure visual function in patients with cataract in various populations. Because results can be population specific, it is recommended that Catquest-9SF be validated in a new population before it is incorporated in routine practice.

The impact of corneal guttata on the results of cataract surgery

To study the impact of corneal guttata on postoperative visual acuity and patients' self-assessed visual function after cataract surgery. Patient data from 49 Swedish cataract surgery units. Retrospective cross-sectional register-based study. Data from patients who had cataract surgery from 2010 to 2017 and completed the Catquest-9SF questionnaire were obtained from the Swedish National Cataract Register. Logistic proportional odds regression was used to model the impact of corneal guttata on the visual acuity and self-assessed visual function. Adjustments were made for age, sex, ocular comorbidities, days to follow-up, preoperative corrected distance visual acuity (CDVA) and preoperative Rasch person score. The main outcome measures were postoperative CDVA and Rasch person score calculated from the Catquest-9SF questionnaire. The study comprised data from 33 741 patients. Cataract surgery greatly improved CDVA and self-assessed visual function in patients both with and without corneal guttata. Still, corneal guttata was significantly associated with a poorer visual acuity and a worse self-assessed visual function after cataract surgery. The negative effect of corneal guttata on visual acuity was most prominent during the first 3weeks postoperatively, but it persisted at least 3months postoperatively. Patients with corneal guttata benefit substantially from cataract surgery but have an additional risk for inferior results compared with patients without corneal guttata. These findings could serve as valuable tools in clinical practice, in particular, when deciding to perform cataract surgery and how to inform the patient about surgical benefits and risks.

Intraoperative difficulties, complications and self-assessed visual function in cataract surgery.

To study associations between intraoperative difficulties and changes in patient-perceived and postoperative visual function and visual satisfaction after cataract surgery. Swedish multicenter, prospective, cross-sectional, nonrandomized, National Cataract Register study. A total of 10979 patients (n=10979) who underwent cataract surgery from 2008 to 2011 completed the Catquest-9SF questionnaire before and 3months postoperatively. Using Rasch analysis, we converted the nonparametric grading of the answers to parametric data and performed parametric statistical analyses. Multiple regression models were used to examine possible predictors associated with self-assessed visual function after cataract surgery. Greater improvement in self-assessed visual function was seen in patients in whom trypan blue dye was used; those without a posterior capsular tear or an ocular comorbidity; and those who were younger, female and had low preoperative corrected distance visual acuity (CDVA) or high postoperative CDVA compared with their counterparts. Significantly higher self-assessed postoperative visual function was seen in patients in whom trypan blue dye was used and those with no posterior capsular tear or ocular comorbidity and no use of capsular hooks; and those who were younger and had low preoperative or high postoperative CDVA compared with their counterparts. The risk of general dissatisfaction after cataract surgery was significantly greater in patients with a posterior capsule tear, ocular comorbidity or low postoperative CDVA, and those in whom mechanical pupillary stretching was performed. Several intraoperative difficulties, posterior capsular tear, ocular comorbidity, age, gender, and preoperative and postoperative CDVAs affect patient improvement and self-assessed visual function after cataract surgery.

Catquest-9SF questionnaire: validation of Malay and Chinese-language versions using Rasch analysis

BackgroundCatquest questionnaire was originally developed in Swedish to measure patients’ self-assessed visual function to evaluate the benefit of cataract surgery. The result of the Rasch analysis leading to the creation of the nine-item short form of Catquest, (Catquest-9SF), and it had been translated and validated in English. The aim is therefore to evaluate the translated Catquest-9SF questionnaire in Malay and Chinese (Mandarin) language version for measuring patient-reported visual function among cataract population in Malaysia.MethodsThe English version of Catquest-9SF questionnaire was translated and back translated into Malay and Chinese languages. The Malay and Chinese translated versions were self-administered by 236 and 202 pre-operative patients drawn from a cataract surgery waiting list, respectively. The translated Catquest-9SF data and its four response options were assessed for fit to the Rasch model.ResultsThe Catquest-9SF performed well in the Malay and Chinese translated versions fulfilling all criteria for valid measurement, as demonstrated by Rasch analysis. Both versions of questionnaire had ordered response thresholds, with a good person separation (Malay 2.84; and Chinese 2.59) and patient separation reliability (Malay 0.89; Chinese 0.87). Targeting was 0.30 and −0.11 logits in Malay and Chinese versions respectively, indicating that the item difficulty was well suited to the visual abilities of the patients. All items fit a single overall construct (Malay infit range 0.85–1.26, outfit range 0.73–1.13; Chinese infit range 0.80–1.51, outfit range 0.71–1.36), unidimensional by principal components analysis, and was free of Differential Item Functioning (DIF).ConclusionsThese results support the good overall functioning of the Catquest-9SF in patients with cataract. The translated questionnaire to Malay and Chinese-language versions are reliable and valid in measuring visual disability outcomes in the Malaysian cataract population.

Improving Patient-Assessed Outcomes after Cataract Surgery

To identify and evaluate possible causes of poor patient-reported visual function after cataract surgery. We obtained retrospective data from the Swedish National Cataract Register on patient self-assessed visual function before and after cataract surgery based on the Catquest-9SF questionnaire. We identified patients who self-reported similar or more difficulties postoperatively than preoperatively, and looked at possible causative variables such as sex, age, preoperative and postoperative corrected distance visual acuity (CDVA) and refractive errors, and ocular comorbidity. Nearly 75% of the 119 patients identified had a better postoperative CDVA; the mean CDVA increased by over 0.2 logarithm of the minimum angle of resolution visual acuity. Patients with low or high preoperative CDVA had poor self-assessed outcomes postoperatively. Younger patients (52-68 years) had a lower self-assessed outcome than more elderly patients. Surgical complications and poor near vision yielded lower outcomes. Anisometropia, ocular comorbidity, and sex did not significantly affect the outcome in this specific group. Patients content with their visual function despite the presence of a cataract should defer surgery. This may also include patients younger than 68 years with good visual function. Detailed information given to the patients about their ophthalmic condition, the surgical procedure and risks, and the eventual need for reading glasses postoperatively may result in higher self-assessed visual function outcomes among patients.

A study of the correlation between patient-reported outcomes and clinical outcomes after cataract surgery in ophthalmic clinics.

To analyse the relationship between patient-reported outcome measures and clinical outcome measures in 42 individual Swedish cataract surgery settings. The study material consisted of follow-up data on cataract extractions collected by the Swedish National Cataract Register in 2008-2011. Patient-reported outcome was measured using the Catquest-9SF questionnaire. A total of 9707 pairs of questionnaires completed before and after a cataract extraction were analysed together with clinical data. The analyses were performed for each clinic. For almost all clinics, a factor related to a poor patient-reported outcome after surgery was a good preoperative self-assessed visual function. For some clinics, up to 50% of the patients stated that they were very satisfied with their vision before surgery. For single clinics, different factors such as large anisometropia (≥3D), capsule complications, biometry prediction error (≥3D) and ocular comorbidity were related to a poor patient-reported outcome. In situations where the clinical outcome was good and the patient-reported outcome was poor, problems with near-vision activities after surgery was the main factor noted. Analysing factors related to a poor patient-reported outcome for each clinic showed large variation. Weak indication for surgery, refractive problems after surgery, surgical complications and a poor chance of visual recovery due to ocular comorbidity were among the reasons for a poor patient-reported outcome. Post-operative care in terms of establishing a good near vision seemed to be another problem for some clinics.

Ocular comorbidity and self-assessed visual function after cataract surgery

To study the association between ocular comorbidities and the change in patient-perceived visual function, postoperative patient-perceived visual function, and visual satisfaction after cataract surgery. Forty-one Swedish cataract surgical units. Clinic-based cross-sectional study. Patients who had cataract surgery from 2008 to 2011 completed the Catquest-9SF questionnaire preoperatively and 3 months postoperatively. Questionnaire data were converted into interval data using Rasch analysis. Multiple regression and logistic regression models were used to examine possible predictors associated with self-assessed visual function after cataract surgery. The total questionnaire was completed by 10,364 patients. Patients without diabetic retinopathy, corneal guttata, glaucoma, macular degeneration, any other comorbidity, or the presence of more than 1 ocular comorbidity had greater improvement in self-assessed visual function than their counterparts. Patients with other factors such as young age, female sex, short preoperative surgical waiting time, and low preoperative and high postoperative corrected distance visual acuities (CDVAs) also had significantly greater improvement in self-assessed visual function than their counterparts. Young patients and those with no specific ocular comorbidities, a short surgical waiting time, and low preoperative and high postoperative CDVAs had significantly higher self-assessed postoperative visual function than their counterparts. Patients without the mentioned ocular comorbidities and a high postoperative CDVA had a higher odds ratio of general satisfaction rather than dissatisfaction than their counterparts. Multiple ocular comorbidities, age, preoperative waiting time, and preoperative and postoperative CDVAs affected patients' improvement and self-assessed visual function after cataract surgery. No author has a financial or proprietary interest in any material or method mentioned.

Analyzing Patient-Reported Outcomes to Improve Cataract Care

The purpose of this study was to analyze three models of how patient-reported outcome measures can be connected to clinical outcome measures in cataract surgery to identify opportunities for improvement of quality of care. Three models were used to analyze the following questions: Is there a relationship between clinical parameters and patient-reported outcomes? (1) Is there a relationship between clinical parameters and a good or poor patient-reported outcome? (2) When and why do clinical and patient-reported outcomes diverge? (3) The study material to exemplify these models consisted of follow-up data on cataract extractions collected by the Swedish National Cataract Register in 2008 to 2011. Patient-reported outcome was measured using the Catquest-9SF questionnaire. A total of 9707 pairs of questionnaires completed before and after a cataract extraction were analyzed together with clinical data. Factors related to any change in patient-reported outcomes after surgery were the preoperative self-assessed visual function, the preoperative visual acuity in both eyes, the postoperative visual acuity, and ocular comorbidity. Factors related to poor patient-reported outcomes after surgery were good preoperative self-assessed visual functions, poor preoperative visual acuity in the better eye, ocular comorbidity, surgical complications, and large refractive deviation. Poor near vision after surgery was the main factor noted in situations where the clinical outcome was good and the patient-reported outcome was poor. Analyses 2 and 3 were the most useful analyses to give ideas for clinical improvement work. The best models to give ideas for improved quality of care by using a patient questionnaire in our study were analyzing the risk factors for a poor patient-reported outcome and analyzing the factors associated with disagreement between clinical outcomes and patient-reported outcomes.

This issue of Acta, printed and electronic

The cover illustration shows a painting of Allvar Gullstrand painted in 1915, 4 years after he received the Nobel Prize for medicine. This issue is dedicated to the centennial of Allvar Gullstrand’s Nobel Prize. He is the only ophthalmologist ever to receive this prestigious price. Stefan Seregard writes an editorial commemorating this event. This is followed by an historical article by Ehinger and Grzybowski on the life and times of Allvar Gullstrand. Yilmaz et al. in USA, Spain and Ireland review the use of intravitreal bevacizumab for diabetic macular oedema. This is an extensive review of the literature for this new and important treatment modality. Lundström et al. in Sweden and Australia found the Catquest questionnaire useful for measuring self-assessed visual function before and after cataract surgery. Mönestam and Behndig found that light scattering and glistening in intraocular lenses does not affect visual acuity. Gazieva et al. in Denmark performed LASIK with two types of laser systems, both which effectively reduce high degrees of myopia with reasonable but slightly different predictability. Rijneveld et al. in the Netherlands found that emergency corneal grafts fail mostly due to host factors, not the quality of the donor tissue. Reinshagen et al. in Switzerland and Germany used mesenchymal stem cell in rabbits to treat total limbal stem cell deficiency. Heijl et al. in Sweden and USA report that intraocular pressure reduction with drug treatment depends on the baseline IOP level and suggest that the baseline IOP level should be documented when reporting treatment effect on intraocular pressure. Larsson et al. in Sweden used the Heidelberg retina tomography system to evaluate optic nerve heads in children. Lin et al. in Taiwan describe lacrimal canaliculitis in a series of patients. Mehlsen et al. in Denmark found that a calcium channel blocker and an angiotensin converting enzyme inhibitor did not influence retinal autoregulation in diabetic patients. Kook et al. in Germany found that intravitreal bevacizumab and/or triamcinolone do not provide long-term improvement for diabetic macular oedema. Kofoed et al. in Copenhagen found that hyperbaric oxygen exposure influenced electrophysiological components related to bipolar in Müller cells. It did not influence retinal thickness. Holton et al. in Denmark examined the influence of light source on contrast sensitivity in patients with AMD. They found that full spectral radiance incandescent light sources seem optimal. Available on http://www.actaophthalmologica.com Stalmans and a large international group review extensively the use of colour Doppler imaging in ocular blood flow research. Founti et al. in Greece and USA found good reproducibility between technicians in imaging retrobulbar blood flow in healthy volunteers. Frøen et al. in Norway and Hungary found that cells from the iris pigment epithelium have limited capabilities as retinal stem cells. Andjelić et al. in Slovenia found that lens capsule contraction with changing in calcium levels or mechanical stimulus. Sieving in USA explains Medline indexing and keywords. Bull in Bergen proposes that fireworks should be banned to reduce eye injuries. Basit et al. in Trondheim describe a case of Wernicke’s encephalopathy in a young boy. Russo et al. in Liverpool found scleral calcification in a case of recurrent melanoma after brachytherapy. Rama et al. in Italy report severe keratitis following corneal cross-linking for keratoconus. Jonas and Jonas in Germany compare peripapillary scleral thickness in glaucoma patients and normal subjects. Lim and An in Korea report good results after epiretinal membrane removal. Kernt et al. in Germany had good experiences with focal and panretinal photocoagulation with a navigated laser. Fielden et al. in Canada describe a cluster of cases with intraocular inflammation following bevacizumab injection. Bloch et al. in Denmark and Egypt describe neovascular membrane contraction and retinal pigment epithelial rupture following verteporfin and bevacizumab treatment. Caramoy et al. in Germany found recurrent choroidal neovascular membrane after autologous RPE transplantation. I wish all readers a Merry Christmas and a Happy New Year and hope that they enjoy reading ACTA during the holidays.

Study of Possible Predictors Associated with Self-Assessed Visual Function after Cataract Surgery

To determine the preoperative or postoperative patient-related factors that make patients benefit more or less from cataract surgery. Multicenter, prospective, cross-sectional Swedish National Cataract Register study. A total of 14 817 patients who underwent cataract surgery from 2000 to 2006 in 42 Swedish ophthalmology departments. The patients completed the Catquest questionnaire before and 6 months postoperatively. The 9 questions in the revised Catquest-9SF were selected from the Catquest and recoded by Rasch analysis, which makes it possible to use parametric statistics when analyzing the study data. The change from preoperative to postoperative, the postoperative mean subjective visual function, and satisfaction with vision were assessed with multiple regression or logistic regression with dummy variables where appropriate, in relation to waiting time, age, preoperative and postoperative corrected distance visual acuity (CDVA), ocular comorbidity, a first- or second-eye surgery, gender, achieved postoperative refraction, correct sign biometry prediction error, and absolute biometry prediction error. Three outcome measures from Catquest-9SF of patient self-assessed visual function after cataract surgery. Young age (P<0.001), low preoperative CDVA (P<0.001), high postoperative CDVA (P<0.001), no ocular comorbidity (P<0.001), and postoperative myopia (-2 to 0 diopters [D]) instead of hyperopia (>0 to +2 D; P<0.05) led to significantly greater improvement in subjective visual function and a better postoperative subjective visual function than the counterparts. Women (P<0.001) and patients who underwent a first-eye surgery (P<0.001) had greater improvement but lower postoperative subjective visual function (P<0.001) than men and patients who underwent a second-eye surgery. A correct sign biometry prediction error of plus instead of minus led to greater improvement in subjective visual function (P<0.01) but no difference in postoperative subjective visual function. The absolute biometry prediction error had no effect on the change in subjective visual function, the subjective mean visual function or satisfaction with vision. Several patient preoperative and postoperative factors are related to the self-assessed benefit of cataract surgery. Age, preoperative and postoperative CDVAs, ocular comorbidity, a first- or second-eye surgery, gender, and achieved postoperative refraction were related to changes in subjective visual function, subjective visual function, and satisfaction with vision.

Lens Opacities Associated with Performance-Based and Self-Assessed Visual Functions

To investigate the relationship of lens opacities to performance-based and self-assessed visual function in persons free of other ocular comorbidities. Cross-sectional cohort study. Beaver Dam Eye Study participants. Lens photographs were taken and graded by protocols for age-related lens opacities. During the study evaluation, best-corrected visual acuity, near vision, and contrast sensitivity (performance-based visual functions) were measured. Questions were asked about visual function in particular settings (self-assessed visual functions). After the exclusion of other ocular comorbidities, performance-based visual functions were associated significantly (P< or =0.001 for each association) with severity of lens opacities, including relatively early lens opacities. Self-assessed visual functions were associated less consistently with severity of lens opacities (P<0.02 for all). In age-stratified analyses, there were fewer significant associations of self-assessed visual functions with severity of lens opacities for persons younger than 65 years than for persons 65 or older. Lens opacities across the range of severities were associated with measurable decreases in visual functions; the associations, especially for self-assessed functions, tended to be greater at older ages. It is likely that successful measures to decrease the severity of lens opacities will have a greater impact on older persons.

Posterior capsule opacification: comparisons between morphology, visual acuity and self‐assessed visual function

To investigate whether posterior capsule opacification (PCO) morphology, visual acuity (VA) and self-assessed visual function correlate, and to compare perceived visual disabilities with those of cataract patients with corresponding VA. Twenty-one patients with PCO were examined before capsulotomy. In adjunct to the ophthalmological examination, the patients completed a Catquest questionnaire and a digitized retroillumation image was acquired. The images were analysed with the Evaluation of Posterior Capsule Opacification (EPCO) program. Data for visual function were compared with data from the National Swedish Cataract Register (NCR). The epco values were correlated with VA in the PCO eyes: the higher the epco score, the lower the VA. There were also correlations between the epco scores, satisfaction with vision, and perceived disabilities in daily life. Symptoms of glare were not significantly correlated with epco scores or with VA. Visual acuity in PCO eyes was better correlated with perceived disabilities and satisfaction with vision than VA in eyes with cataract. There was a significant correlation between epco scores and VA and between epco scores and Catquest. Consequently, the morphological method was related to the self-assessed visual function. Patients with PCO seemed to have more disturbed visual function, as defined by Catquest, than cataract patients with the same VA.

Benefit to patients of bilateral same-day cataract extraction: Randomized clinical study

To compare patients' self-assessed visual function after bilateral surgery performed on the same day with visual function after surgery in 1 eye at a time. Department of Ophthalmology, Blekinge Hospital, Karlskrona, Sweden. Patients with bilateral cataract were assigned randomly to 2 groups, patients having bilateral surgery on the same day and patients with 2 surgeries done 2 months apart. Both groups were examined before and 2 months and 4 months after surgery. All patients completed the Catquest questionnaire at each ophthalmic examination. Until both eyes were operated on, patients having surgery in 1 eye had significantly more difficulties performing daily life activities (P<.001) and a worse binocular contrast sensitivity (P<.01) than patients who had bilateral surgery on the same day. Four months after surgery of both eyes in both groups, there was no difference in visual function. Bilateral cataract surgery on the same day allowed rapid rehabilitation of the patient and helped avoid suboptimal visual function in daily life while waiting for second-eye surgery. However, there was no extra long-term benefit of self-assessed visual function compared with cataract surgery in 1 eye at a time.

Self‐assessed visual function for patients with posterior capsule opacification before and after capsulotomy

To describe the functional outcome, as defined using the Catquest questionnaire, for patients with posterior capsule opacification (PCO) after capsulotomy. A total of 47 patients with PCO were examined before and 1 month after capsulotomy. In addition to the ophthalmic examination, Catquest was completed and a digital image of the posterior lens capsule acquired. Capsulotomy resulted in a good level of benefit, as defined using Catquest, for 77% of the patients. No subgroup of patients who derived an exceedingly good or poor level of benefit was identified. Disabilities in daily life, satisfaction with vision and symptoms of glare improved from treatment (p < 0.001, p < 0.001 and p = 0.002, respectively). The results were comparable with the benefits of cataract surgery. Self-assessed visual function as defined using Catquest improved after capsulotomy for the vast majority of patients with PCO. No group of patients with exceptionally good or poor levels of benefit could be identified with certainty. However, the majority of those with a poor outcome were elderly individuals with ocular comorbidity. The overall functional results from treatment of PCO were very similar to those achieved after cataract surgery.

Modeling utility of second-eye cataract surgery.

To study the impact on public health in terms of utility of various proportions of first-eye and second-eye cataract surgery. A model was used to study the impact on a population of a fixed cataract surgical rate (9,250 operations/1,000,000 people) with varying proportions of first-eye and second-eye cataract operations. The study population was the County of Blekinge with a known incidence of previous cataract surgery. The prevalence of cataract, the estimated need for cataract surgery, and the utility values were taken from the literature. The population was grouped by disability stage of cataract and previous cataract surgery in accordance with prevalence studies and data from a large national database on cataract surgery and patients' self-assessed visual function. The mortality rate was taken from real data for the study population. Given a fixed cataract surgical rate over a period of five years, a high percentage of second-eye cataract surgery (42 percent) resulted in a mean utility of 0.82239 in the population forty years of age and older and the corresponding number for a low percentage of second-eye cataract surgery (25 percent) was 0.82253. A high percentage of second-eye surgeries resulted in 421 more individuals who were well compared with a low percentage of second-eye surgeries. On the other hand, a low percentage of second-eye surgeries resulted in 152 fewer individuals with disability and 118 fewer individuals with dependence compared with a high percentage of second-eye surgeries. A high frequency of first-eye cataract surgeries instead of second-eye surgeries affects more individuals and means an optimized improvement of utility in a population. This should be recommended if the cataract surgical rate is very insufficient. If the cataract surgical rate is high, more second-eye surgeries should be performed to optimize quality of life to as many as possible.

The Swedish National Cataract Register: A 9-year review.

The Swedish National Cataract Register (NCR) has been collecting data on cataract extractions in Sweden since 1992. This unique national database now contains data pertaining to more than 400 000 operations, representing 93.4% of all operations performed nationwide during 1992-2000. Clinic participation in the NCR is voluntary. Tests have shown NCR data to be extremely reliable, while the participation of nearly all providers of cataract surgery in Sweden makes the data highly representative of cataract surgery throughout the country. The NCR collects pre- and per-operative data for every cataract extraction performed at participating clinics. Surgical outcome data and data about patients' self-assessed visual function is collected in approximately 10% of cases. Since 1998, all cases of suspected postoperative endophthalmitis have also been reported to the NCR. The rate of surgery has increased from 4.47 to 7.26 per 1000 inhabitants during the period. Female subjects have constituted about 66% of all operated subjects each year and the mean age of patients has slowly increased from 75.2 to 76.1 years. Average pre-operative visual acuity has improved each year. Second eye surgery has increased from 28.5% to 36.8% of all surgeries. Phacoemulsification has reached 98% as type of surgery (in 2000) and 92.7% of all intraocular lenses are foldable. Surgical outcome has improved by achieving a final refraction closer to the target refraction and less surgically induced astigmatism. The positive impact of cataract surgery in very elderly people has been demonstrated, as has the positive effect of second eye surgery, especially in young subjects. The NCR has served to enhance knowledge about trends and results of cataract surgery in Sweden. This review article describes some of the activities carried out and their results.

Quality of life after first- and second-eye cataract surgery : Five-year data collected by the Swedish National Cataract Register

Purpose: To study the benefits of surgery and satisfaction with vision after first- and second-eye cataract surgery in comparable groups of patients. Setting: Clinics participating in the Swedish National Cataract Outcome Study from 1995 to 1999. Methods: A prospective observational study evaluated patients’ self-assessed visual function and satisfaction with vision before and 6 months after cataract extraction. Patients who had another cataract surgery in the fellow eye during the 6-month study were excluded. Data of 8595 patients having cataract extraction at participating clinics during the month of March for 1995 to 1999 were collected. Preoperative and intraoperative data were reported at the time of surgery. Final postoperative visual acuity was recorded. The Catquest questionnaire was completed before surgery and 6 months after surgery. Results: First-eye surgery was performed in 5570 patients and second-eye surgery, in 3025. Patient-assessed benefits of surgery and satisfaction with vision as defined by the Catquest was higher after second-eye surgery ( P < .001). The outcomes were studied in detail in patients with equal visual acuity in the fellow eye before and after surgery and without ocular comorbidity. The better outcome after second-eye surgery was most pronounced in patients with good or intermediate visual acuity in the fellow eye. Conclusion: The self-assessed visual outcomes and satisfaction with vision were better after second-eye surgery than after first-eye surgery in comparable groups of patients.

Cataract surgery in the very elderly

ObjectiveTo analyze the outcome of cataract extraction in patients aged 85 years and older (≥85 group) and to compare their outcome with that of patients younger than 85 years (≤84 group). SettingCataract surgeons participating in the Swedish National Cataract Outcome Study during 1995 to 1997. MethodsA prospective observational study was performed that evaluated patients’ self-assessed visual function before and 6 months after cataract extraction. Mean age of the 4819 patients having cataract extraction at participating clinics during March 1995, 1996, and 1997 with complete follow-up data was 75.6 years; 67.5% were women. Preoperative and intraoperative data were reported at the time of surgery. Final postoperative visual acuity, refraction, and keratometry were recorded. Each study period closed 6 months after surgery. The Catquest questionnaire was completed before surgery and 6 months after surgery. ResultsOf those with complete data, 757 patients (15.7%) were in the ≥85 group. In this group, visual acuity in the operative eye improved in 84.3% and a visual acuity of 0.5 or better was achieved in 71.4%. A no-benefit outcome, as defined by the Catquest questionnaire, was found in 12.7% of the ≥85 group and 8.4% of the ≤84 group. ConclusionElderly patients on average had a good outcome, although not as good as that in younger patients. Certain groups were identified as having an excellent result and others of having a high risk of an adverse outcome.